Friday, September 9, 2016

Tumor Board

The Nightingale: So I've got another one. 64 year old female with a history of lobular breast cancer, ER PR positive Her2neu negative. Been managing fine for 5 years. Now picked up leptomeningeal spread on MRI scan. Asymptomatic. Healthy, doing well. What should I do?

We all looked at the meningeal enhancement on the MRI displayed at the front of the room. The radiologist pointed out the areas. Various scenarios of treatment were kicked around.

Swagger and Sagacity: I'm glad the word "Omaya reservoir" was not uttered from anyone's lips. That's like trying to rearrange deck chairs on the Titanic.

I remember seeing routine positive CSF's from a case in Conway, until we no longer covered there a year or so ago. This lady had ductal, though. The CSF's were obtained through her Omaya reservoir. When I first saw the fluid, I thought "This lady's a goner." Eight years later she was still alive. I gathered based on this conversation that she was an outlier.

The Owl: Yeah, that'll buy you two months, maybe. It's a big waste of time.

The Nightingale: Thank you all that was really helpful. I mean lobular? Chronic disease. She will be alive for a while.

Here's a normal brain MRI I cribbed off of the web. I hope her next scan looks like this.